Objective To compare early enteral with parenteral nutrional support in patients after hepatectomy. Methods In this study, 59 patients were randomized into 2 groups to respectively receive enteral or parenteral nutritional support beginning the first day post-op for a week. The general nutrition condition, liver function, gut function, dosage of albumin, mortality, complication rate and expense were recorded. Results Patients were given same quantity of heat and nitrogen. At the end of the study, serum albumin, body weight and upper arm circumference had not reached the preoperative level in patients receiving enteral mutrition while all except for serum prealbumin had not reached the level in parenterally nutritional patients. Furthermore, the time of gut begins functional (29?12) h in enterally nutritional patients was shorter than in parenterally nutritional patients (38?14) h. Enteral nutrition was more economic than parenteral nutrition (P

Objective To explore the risk factors of hyponatremia in postoperative patients with aneurysm and analyze the clinical characterstics in order to provide reference for clinic.Methods Participants included 120 patients who treated by aneurysm occlusion.Detailed recorded the patient's history and basic information.The patients with hyponatremia were in case group,and other patients were in control group.The risk factors of hyponatremia were analyzed.Results Forty-five patients (37.5％) occurred hyponatremia after operation.The level of natrium was (125.2 ± 10.1) mmol/L,the average time of appear hyponatremia was (8.2 ± 0.8) d,15 patients were in the first peak(postoperative 1-3 d),25 patients were in the second peak (postoperative 8-9 d),5 patients occurred hyponatremia at other time.Thirty-nine patients were internal carotid artery aneurysms,6 patients were vertebrobasilar artery aneurysms.Single factor analysis showed that the age,preoperative GCS scores,history of hypertension and diabetes,emergency operation,the size of arterial aneurysms,medium-sized aneurysm of artery between two groups had significant difference [(48.7 ± 8.4) years vs.(54.7 ± 8.4) years,(14.4 ± 3.1) scores vs.(10.3 ± 3.4)scores,26.7％ (20/75) vs.60.0％ (27/45),33.3％ (25/75) vs.62.2％ (28/45),32.0％ (24/75) vs.62.2％(28/45),(0.9 ±0.3) cm vs.(1.4 ±0.4) cm,24.0％(18/75) vs.42.2％(19/45),P ＜ 0.01 or ＜ 0.05].Multifactors regression analysis showed that preoperative GCS scores,emergency operation were the independent risk factors of hyponatremia (P＜ 0.05).Conclusions Postoperative 1-3 d and 8-9 d are the peak stage of hyponatremia.Different treatment should be adopted according the peak stage.Lower scores of preoperative GCS and emergency operation are the independent risk factors of hyponatremia.Clinical work need to pay more attention to the risk factors,appropriate treatment and prevention.

ObjectiveTo investigate the role of electroencephalogram (EEG) examination in the prognosis evaluation of patients with severe craniocerebral injury.MethodsFifty-seven patients with severe craniocerebral injury were selected as study subjects and their clinical data were analyzed retrospectively.All the patients got EEG examination,and the relationships between EEG grading and Glasgow coma scale (GCS) score,the prognosis of outcome were analyzed.ResultsThe EEG of 57 patients within 24 h after hospitalization were all abnormal.There was significantly negative correlation between EEG grading and GCS score (r =-0.742,P ＜0.05).EEG grading was significantly positively correlated with the prognosis of outcome (r =0.730,P＜ 0.05).ConclusionsEEG examination and EEG grading can evaluate the prognosis of patients with severe craniocerebral injury.It provides reference for clinical treatments.

ObjectiveTo evaluate the efficacy of mini-incisional double-tsuge suture method with 0-0 absorbable polydioxanone-cord (PDS-Ⅱ)in repair of acute achilles tendon rupture.MethodsA total of 34 patients were subjected to acute closed achilles tendon ruptures,including 25 males and 9 females at a mean age of 32 years ( range,20-45 years).Injury causes included sports injuries in 27 patients,falling injuries in six and heavy object impingement injury in one.The time from injury to operation was average 3 days (range,1-6 days).All patients underwent minimally invasive repair with double-tsuge suture method by using PDS-Ⅱ.The ankle joint was fixed with short leg plaster cast at 30° plantar flexion position and the cast was removed six weeks later to take functional exercise.The patients could walk with full weight-bearing 8-10 weeks later and could gradually return to activity 3-4 months later.Results There was one patient with poor incision healing and one patient with reflex sympathetic dystrophy postoperatively.The rest patients had stage Ⅰ incision healing without skin adhesions.No complications such as infection,lower extremity deep venous thrombosis or sural nerve injury occurred postoperatively.All the patients received follow-up of 12-24 months (average 15 months),which showed no complications like tendon rerupture occurred.According to clinical evaluation criterion of Termann,the average score was 92 points (range,76-96 points).The result was excellent in 28 patients,good in five and fair in one,with excellence rate of 97％.ConclusionsSmall incisional double-tsuge suture method achieves low rate of complications and good outcomes for repairing acute achilles tendon rupture and is an ideal tendon surgery approach.

ObjectiveTo study the clinical effect of YL-1 type hematoma puncture needle in the treatment of basal ganglion region cerebral hemorrhage.MethodsSixty-two patients with hypertensive basal ganglion region cerebral hemorrhage were treated by YL-1 type hematoma puncture needle from January 2007 to May 2011 (minimally invasive punctural evacuation group),of which,60 patients were treated by conservative treatment(conservative treatment group) as control,compared two groups of neural function defect score,hematoma clearance rate on admission,after 3 weeks treatment,and quality of life after 6 months.ResultsNeural function defect score on admission of minimally invasive punctural evacuation group was (23.6 ± 18.4) scores,while (23.4 ± 17.8) scores in conservative treatment group,the difference was not statistically significant(P ＞ 0.05).After 3 weeks' treatment,neural function defect score and hematoma clearance rate of minimally invasive punctural evacuation group was superior to conservative treatment group [ (14.6 ± 12.4) scores vs.(20.1 ± 18.4) scores,(92.3 ± 5.4)％ vs.(79.5 ± 13.8)％ ] (P ＜0.05 ).After 6 months' treatment,the good rate of quality of life in minimally invasive punctural evacuation group was 81.7％(49/60),which was significantly increased compared with that of conservative treatment group [67.2％ (39/58)] (P ＜ 0.05).ConclusionsThe minimally invasive punctural evacuation in the treatment of basal ganglion region cerebral hemorrhage has small invasion,better prognosis,effective and fast decompression of intracranial hematoma,reducing disability rates,improvement of the quality of life,which could be a beneficial complement for traditional therapies.

Objective To investigate the dynamical changes of Rho kinase in the cerebrospinal fluid (CSF) and its relationship with cerebral vascular spasm CVS. Methods CSF were collected on the ist, 3rd, 7th, 10th and 14th day after subarachnoid hemorrhage. The expression of Rho-kinase mRNA in CSF was determined by RT-PCR. The expression of endothelin-1 in CSF was determined by radioimmuno-assay. TCD was used to measure the velocity of the cerebral artery. Results The levels of ET-1 and Rho-kinase mRNA in CSF were re-markably increased on the 3rd day, and reached at the peak on the 7th day after subarachnoid hemorrhage, which were significantly higher than those without CVS. Conclusion There is a positive correlation between the level of Rho-kinase mRNA and ET-1 in CSF. Rho-kinase may participate in the development of CVS.

Objective: To explore mechanism of fasudil combined salmeterol and fluticasone propionate powder for inhalation (Seretide) in treating chronic obstructive pulmonary disease (COPD) complicated pulmonary artery hypertension (PAH).Methods: A total of 120 patients accorded with diagnostic standards of COPD and PAH, who hospitalized in our department from Jan 2013 to Oct 2014, were selected.According to random number table method, patients were randomly and equally divided into routine treatment group, fasudil group (received intravenous drip of fasudil based on routine treatment group) and combined treatment group (received additional Seretide therapy based on fasudil group).Levels of nitric oxide (NO), endothelin-1 (ET-1), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured and compared among three groups before and after treatment.Results: Compared with before treatment, after two-week treatment, there were significant reductions in levels of CRP, ESR and ET-1, and significant rise in NO level in three groups, P<0.05 or<0.01;compared with routine treatment group after treatment, there were significant reductions in levels of CRP[(14.8±3.3) mg/L vs.(12.9±3.6) mg/L vs.(11.4±3.4) mg/L], ESR[(37.3±8.9) mm/h vs.(32.9±8.8) mm/h vs.(29.3±5.6) mm/h]and ET-1[(63.1±11.2) ng/L vs.(57.5±8.1) ng/L vs.(53.1±8.9) ng/L], and significant rise in NO level[(70.2±10.7) μmol/L vs.(76.0±8.0) μmol/L vs.(80.5±11.3) μmol/L]in fasudil group and combined treatment group, P<0.05 or<0.01;compared with fasudil group, there were significant reductions in levels of CRP, ESR and ET-1, and significant rise in NO level in combined treatment, P<0.05 all.Conclusion: Fasudil hydrochloride combined Seretide can significantly reduce levels of ESR, CRP and ET-1, and increase NO level in COPD + PAH patients.It may improve prognosis in these patients, which is worth extending.

Objective:To explore therapeutic effect of Fasudil combined Salmeterol Xinafoate and fluticasone propio‐nate powder for inhalation (Seretide) on patients with chronic obstructive pulmonary disease (COPD) combined pul‐monary arterial hypertension (PAH ) .Methods :A total of 120 patients ,who hospitalized in our department from Jan 2013 to Oct 2014 and conformed to diagnostic standards of COPD and PAH ,were selected .According to ran‐dom number table ,they were equally divided into routine treatment group (received routine therapeutic measures ) , Fasudil group (received Fasudil based on routine treatment group ) and combined treatment group (received Fasudil combined Seretide based on routine treatment ) . Pulmonary function indexes , mean pulmonary arterial pressure (mPAP) ,pulmonary arterial systolic pressure (PASP) ,6min walking distance (6MWD) and blood gas indexes were observed and compared among three groups before and after treatment .Results:Compared with routine treatment group after treatment ,there were significant reductions in mPAP [(54.1 ± 10.3) mmHg vs .(51.3 ± 9.5) mmHg vs . (48.5 ± 10.5) mmHg] and PASP [ (72.4 ± 9.7) mmHg vs .(63.4 ± 9.3) mmHg vs .(61.6 ± 9.1) mmHg] ,and sig‐nificant rise in 6MWD [ (259.4 ± 37.0) m vs .(274.2 ± 36.5) m vs .(288.3 ± 47.5) m] ,forced expiratory volume in one second [FEV1 ,(1.44 ± 0.32) L vs .(1.59 ± 0.38) L vs .(1.87 ± 0.34) L] and FEV1/forced vital capacity (FVC) [ (47.2 ± 11.9)% vs .(50.3 ± 12.1)% vs .(54.6 ± 11.7)% ];significant rise in partial pressure of oxygen in artery [PO2 ,(64.3 ± 9.8) mmHg vs .(68.9 ± 8.2) mmHg vs .(76.9 ± 9.5) mmHg] and saturation of arterial blood oxygen [SaO2 ,(65.0 ± 8.2)% vs .(71.0 ± 9.8)% vs .(76.8 ± 9.4)% ] ,and significant reduction in partial pressure of carbon dioxide in artery [PCO2 ,(63.6 ± 9.5) mmHg vs .(58.5 ± 9.6) mmHg vs .(51.3 ± 7.9) mmHg] in Fasud‐il group and combined treatment group ,and those of combined treatment group were significantly improved com‐pared to those of Fasudil group , P<0.05 or <0.01. Actual base excess of combined treatment group was signifi‐cantly higher than the other two groups , P<0. 01 both . Conclusion:Fasudil combined Seretide can significantly im‐prove pulmonary function reduction ,improve PAH ,quality of life and prognosis in COPD + PAH patients .

Objective To study the clinical characteristics and treatment of esophageal injury caused by button battery foreign bodies in children, then improve the diagnosis and management level of this hazardous problem of children. Methods 15 patients with esophageal injury caused by button battery foreign bodies were retrospectively analyzed the clinical characteristics, treatment and prognosis. Results 12 button battery foreign bodies were removed successfully with rigid esophagoscope, 3 with electronic gastroscope. 12 cases occurred serious esophageal lesions, 10 patients were fully recovered after nasal feeding, anti-inflammatory and supporting therapy. Serious complication such as esophageal perforation occurred in 2 cases, one of them occurred tracheo-esophageal fistula. Conclusion Button battery embedded in the esophagus is easy to cause serious esophagus injury, early detection is the key of the management, and its prompt removal is mandatory. Button battery have a distinctive appearance on radiography, chest radiographs can be used as the first choice of diagnosis. The reasonable treatment can obtain better curative results and avoid serious complications according to the course of the disease and esophageal damage degree. Physicians must recognize the hazardous potential and serious implications such as esophageal perforation and tracheo-esophageal fistula.

It is extremely necessary and important for colleges or universities to transform the education concepts that barricade students' initiative and creativity, especially the one that takes fi-nal examinations as sole standard to evaluate teaching and learning effects. In order to display and cultivate students' study ability more comprehensively, we manage to establish a set of formative eval-uation system for regional anatomy course , which involves tests and examinations and evaluations throughout the whole teaching and learning process. It solves the long-lasting problem that examina-tions are final purposes of teaching and learning, and thus, teaching values not only results but also learning process, which directs students' attention to conventional studies and helps develop good study habits, greatly reducing the randomness of final academic performances. The diverse assessment methods, along with accumulated assessment results, can improve students' learning effects through-out the whole semester. The fundamental purpose of this system is to inspire students' passion for study and creativity and monitor the teaching process.